Shigella Attorney

The Vermont Department of Health is investigating an outbreak of an antibiotic-resistant bug that sickened 70 people at a retirement community.

Investigators have confirmed 22 cases of Shigellosis and 48 others have shown symptoms consistent with the bacteria at the Wake Robin retirement community in Shelburne.

The Shigella bacteria can cause diarrhea and fever.

The investigation into the outbreak began a month ago, and units were quarantined for a time. Officials say there have been no new cases in several weeks

Health Commissioner Mark Levine said the federal Centers for Disease Control and Prevention are assisting because the bacterial strain is resistant to antibiotics. He said most affected people needed five to seven days to recover.

The Vermont Health Department is investigating an outbreak of gastrointestinal illness at Wake Robin, a retirement community in Shelburne. Specimens from seven individuals have tested positive forShigella sonnei. More than 50 individuals associated with the facility, or with someone who lives or works at the facility, have reported symptoms consistent with shigellosis.

Consider Shigellosis When Evaluating Clinically Compatible Illnesses

Clinical manifestations of shigellosis range from watery or loose stools with minimal symptoms to more severe illness including high fever, abdominal cramps or tenderness, tenesmus, and mucoid stools with or without blood. Symptoms usually resolve in five to seven days but sometimes last for four or more weeks. Asymptomatic infection is possible.

Shigella bacteria are present in the stools of infected people while they have diarrhea, and for up to four weeks after symptoms resolve. The primary mode of transmission is fecal-oral, although transmission can also occur via contact with a contaminated fomite, ingesting contaminated food or water, or sexual contact. The incubation period is one to seven days, but is usually less than four days.

Report all suspected and confirmed cases to the Health Department’s Infectious Disease – Epidemiology program at 802-863-7240.

Test for Shigella

Clinicians who see patients with symptoms of shigellosis are encouraged to collect a stool specimen and have it tested for Shigella. Antibiotic resistance is relatively common, so susceptibility testing of clinical isolates is indicated to guide appropriate therapy. To date, testing of isolates associated with this outbreak has indicated susceptibility to Ciprofloxacin and resistance to Ampicillin and Trimethoprim-Sulfa. Hospital or reference laboratories in Vermont should forward Shigella isolates or original specimens to the Health Department Laboratory for further testing such as molecular subtyping (performed at no charge).

Submit specimens through the existing hospital courier service for receipt at Health Department Laboratory within 48 hours. Stool specimens should be collected and preserved in Cary-Blair medium. VDHL Kit #1 (which may be obtained at no charge by contacting theLaboratory’s Customer Service at 802-338-4724), or an appropriate culture specimen container (available from hospital laboratories) should be used for the collection and transport.

Treatment

Shigellosis is usually self-limited and treatment with antibiotics is not generally recommended in otherwise healthy adults with mild illness. However, antibiotics may be prescribed when warranted by the severity of the illness, underlying health conditions, or patient’s occupation. Anti-diarrheal medication that inhibits peristalsis, such as loperamide (e.g. Imodium) or diphenoxylate with atropine (e.g. Lomotil) are contraindicated and may prolong illness and increase the rate of complications.

Prevent New Cases

Strict attention to hand hygiene is essential to limit spread. Symptomatic children who attendday care should stay home until the Health Department says it’s safe to return. People with confirmed shigellosis who work as health care providers, child care workers or food handlers should be excluded from work until two consecutive negative stool cultures (collected 24 hours apart and at least 48 hours after discontinuation of antibiotics) have been documented.

Symptomatic people should not prepare food or share food with others. They should not swim and should not have sex (vaginal, anal, and oral) for one week after diarrhea has resolved.

Shigellosis Information for Clinicians

Resources for clinicians are available on the Health Department’s website:

The San Diego County Health and Human Services Agency is advising gay and bisexual men, homeless individuals, and people with compromised immune systems that they could be at an increased risk for the intestinal disease shigellosis.

According to the Centers for Disease Control and Prevention, young children and travelers to developing countries are also at risk for shigellosis.

Last year, the County saw the highest number of cases in 20 years, including a disproportional increase in the gay and bisexual community and among the homeless population.

The number of cases typically increases in the late summer and fall and there have already been 98 cases of shigellosis reported in the county so far in 2018. In 2017, a total of 334 cases were reported, representing a 37 percent increase compared to 2016 when there were 232 cases.

A larger proportion of 2017 cases (63 percent) were among men, many of whom self-identified as gay or bisexual, compared to previous years. Additionally, the percentage of homelessness cases also experienced an increase from 7 percent of total cases to 12 percent from 2016 to 2017.

So far in 2018, 25 percent of the reported cases involve gay or bisexual men and 7 percent involve homeless people.

The Shigella infection or Shigellosis causes a diarrheal illness lasting for 5 to 7 days. Shigella is very contagious. Infection can occur through person-to-person contact, eating food contaminated by someone who has shigellosis, or swallowing water from pools and ponds or drinking water that was contaminated with the bacteria.

“Shigellosis is a very contagious disease, but there are many steps people can take to reduce their chances of getting it,” said Wilma Wooten, M.D., M.P.H., County public health officer. “The infection can be prevented by conducting frequent and thorough hand washing; disinfecting any areas that may be contaminated, such as restrooms or diaper changing areas; avoiding swallowing water from untreated pools and ponds, and not preparing or serving food to others when having diarrhea.”

HHSA is recommending that those at risk, including gay and bisexual men and homeless people:

Practice good hand hygiene at all times washing your hands with soap and water, especially before eating or preparing food for others or changing diapers

Avoid swallowing water from ponds, lakes or untreated swimming pools

Be aware of your HIV status

Be aware of the local increase in shigellosis, which can be a severe illness, particularly in those with reduced immunity.

Seek care for diarrheal illness, especially with fever or bloody diarrhea, and be sure that their healthcare provider tests to see if symptoms are caused by Shigella.

Discuss antibiotic treatment for shigellosis with their doctors to shorten the duration of illness and reduce the risk of infecting others.

Abstain from sex, for several days after you stop having diarrhea, to prevent spreading the illness to others.

Several persons associated with a Lexington County pre-K may have been infected with a contagious bacteria, according to a letter issued by the state’s health department.

Parents of the Lexington 4 Early Childhood Center in Swansea were sent a letter with a Friday date warning of shigella, an “easily spread” bacteria that can lead to an infection of the lining of the stomach, according to a letter sent by the S.C. Department of Health and Environmental Control.

Fever, stomach cramps and diarrhea are among the common symptoms associated with the infection, the DHEC letter stated. They typically last five to seven days.

In early September 2017, an over-30-year-old male who resides in northern Taiwan traveled to Bali, Indonesia with 18 tour group members. On the following day the case returned, he sought medical attention after developing symptoms, including fever, diarrhea and nausea, and was diagnosed with shigellosis. After a further investigation conducted by the health authority, a female group member who is over 20 years old had also experienced symptoms, including vomiting and diarrhea and was also diagnosed with shigellosis. According to the cases, they consumed mostly cooked food while in Bali. However, they had seafood at a restaurant with poor hygiene. Hence, it was determined that these two cases constitute a cluster. As of now, none of the contacts residing in the same household with the 2 cases has developed suspected symptoms. Moreover, the local health authority has collected specimens from the other 13 tour group members who experienced symptoms for laboratory testing.

Ventura County Public Health was notified on Thursday, June 22nd, of an unusually high number of Shigella cases in the county. Shigellosis is an infectious disease caused by a group of bacteria called Shigella (shih-GEHL-uh), which most often causes diarrhea and fever. It is highly contagious.

Through a series of interviews with those affected, it has been determined that a number of the cases reported to have eaten at the Souplantation in Camarillo. Of the diners interviewed, there are a total of eight individuals with laboratory evidence of Shigella infection.

Ventura County Public Health’s laboratory sent the culture confirmed samples to the State laboratory for typing.

“We’re tracking these cases closely,” said Public Health Officer Dr. Robert Levin, “and are working closely with Ventura County Environmental Health, which has completed two inspections of the restaurant in the past two days.” Dr. Levin credits Souplantation corporate office for making the decision to close the restaurant, starting Thursday through the weekend, to make certain that all steps have been taken to prevent further cases.

The Souplantation Chief Operating Officer has arrived at the Camarillo location and has been joined by a vice- president and the quality assurance manager. All employees are being put through a sanitary training refresher course, the restaurant is being thoroughly cleaned and all food on the premises is being thrown out.

“Souplantation’s actions have been exemplary. This is the kind of swift and decisive action, which leads to a collaboration with Public Health that results in a rapid resolution of the problem,” added Dr. Levin.
It is not currently clear what the source of the infection is. No one food item has been indicated. All employees are being tested and will need to be cleared before returning to work. There are approximately 40 employees at the restaurant.

Most people who are infected with Shigella develop diarrhea, fever, and stomach cramps starting a day or two after they are exposed to the bacteria. Shigellosis usually resolves in 5 to 7 days. Some people who are infected may have no symptoms at all, but may still pass the Shigella bacteria to others. The spread of Shigella can be stopped by frequent and careful hand-washing. Antibiotic treatment is known to decrease the length of illness and to end shedding of the organism within a day or two of starting therapy. People most at risk of serious illness are those with underlying immunosuppressive conditions. Those who may have been exposed who are feeling ill should consult their physician.

Florida health officials in Seminole County are warning about a shigella outbreak at a daycare. A shigella outbreak was reported to Florida Health Department officials on Tuesday at the Kids City USA daycare in Altamonte Springs. According to the Centers for Disease Control and Prevention, symptoms appear one to two day after exposure, with diarrhea, fever and abdominal pain. CDC said symptoms last five to seven days; however, people with mild cases may only need fluids and plenty of rest. In severe cases, antibiotics may be used. However, shigella is antibiotic-resistant. The bacteria is highly contagious, CDC officials said. A tiny amount of exposure to contaminated stool can cause infection. Health officials said the daycare is still open. CDC recommends that if an outbreak occurs at a daycare, to have a child who is infected with diarrhea to stay home and children who have recently recovered to be placed in one classroom to minimize the risk of exposure. Also, staff should be assigned to change diapers and prepare the food, the CDC said. Young children and travelers are among the most at-risk groups of being affected.

The Arkansas Department of Health (ADH) is continuing to see cases in Northeast Arkansas of Shigellosis, an infectious disease that commonly causes diarrhea, fever and stomach cramps. Shigellosis is caused by the Shigella bacteria and is very contagious. The ADH urges residents to wash their hands and take other protective measures to keep Shigella from spreading.

In Louisiana, Dr. Anatole Karpovs, pediatrician with The Children’s Clinic of Southwest Louisiana, has been treating young patients with shigellosis, caused by a group of bacteria called shigella.

“It causes specifically diarrhea and high fevers,” said Dr. Karpovs “It sometimes causes bloody diarrhea or pus or mucus in the diarrhea.”

Dr. Karpovs says most people infected with shigella start experiencing these symptoms within a day or two of exposure to the bacteria. It spreads easily through fecal-oral routes.

“If a child has diarrhea and that spreads or gets on a surface and somebody touches it unknowingly, then they can spread it to themselves or other people,” he said.

Anyone can be infected, but some people might not even know it.

Those most at risk are people with weakened immune systems, the elderly, and the young.

Stanislaus County has seen an increase in Shigella infections this year. According to the Stanislaus County Health Services Agency, there has been 123 confirmed cases of Shigella in the county this year, which is a significant increase from the 19 reported in 2015.

Most Shigella infections are the result of bacteria passing from improperly washed hands from one person to the mouth of another person, often through handling contaminated objects or food. Poor hand washing and hygiene, especially after changing diapers or toileting, increases the risk of infection.

“Regular and frequent hand washing with soap and running water is the single most important preventive measure to interrupt the spread of shigellosis. Everyone should thoroughly wash their hands after using the restroom or changing diapers and before eating or preparing food. People diagnosed with Shigella infection should be especially vigilant in their hand washing practices,” said Dr. John Walker, the public health officer for Stanislaus County.

Shigellosis is a highly infectious disease caused by a group of bacteria called Shigella. People infected with Shigella may have fever, stomach cramping, and mild or severe diarrhea, often with traces of blood or mucus in the stool. However, some infected people may not show any symptoms at all. Symptoms occur from one to seven days after exposure, but usually within one to three days, and last an average of four to seven days.

Approximately 500,000 cases of Shigella are reported in the United States each year, according to the Centers for Disease Control and Prevention. In 2013, the CDC declared antibiotic-resistant Shigella an urgent threat in the United States. These cases had been seen for years overseas, but more recently, the CDC has seen outbreaks of the infection that are resistant to the two main prescribed antibiotics for Shigella — ampicillin and trimethoprim-sulfamethoxazole. About 27,000 Shigella infections in the United States every year are resistant to one or both of these antibiotics. When pathogens are resistant to common antibiotic medications, patients may need to be treated with medications that may be less effective, but more toxic and expensive.

Food Safety News reports that along with the highly publicized lead contamination of its water supply, Flint, MI, also bears the dubious distinction of having the highest number of Shigella cases in the state.

The Genesee County Health Department has reported 85 cases so far this year, with more than half of them within the Flint city limits. Twenty-seven people have been hospitalized. A higher-than-normal number of shigellosis cases is also being reported in Saginaw County, which borders Flint.

In a statement issued Wednesday, the Michigan Department of Health and Human Services noted that the 85 Genesee County cases compares with 20 shigellosis cases reported there in 2015 and four cases in 2014.

Shigellosis is a highly contagious disease caused by four different strains of Shigella bacteria. Even a microscopic amount of contaminated fecal matter in food or water can cause infection if consumed.

Most people infected with the bacteria develop diarrhea, fever and stomach cramps within a day or two after being exposed. The symptoms usually resolve within five to seven days.

Some people who are infected may have no symptoms at all, but may still pass the Shigella bacteria to others. The spread of Shigella can be stopped by frequent and careful hand-washing with soap and by taking other hygiene measures.

Flint’s water contamination problems began in April 2014 when the city switched its source from treated Lake Huron and Detroit River water to the Flint River. Because officials did not add corrosion inhibitors to the highly corrosive river water, it caused lead from aging pipes to leach into the city’s water supply.

Between June 2014 and November 2015, there were 87 cases of infection with Legionella bacteria reported in Genesee County. Ten of those people died. However, no direct link was made between the spike in Legionnaires’ disease and the change in the water system.

Some public health officials are speculating that the current shigellosis problem stems from Flint residents being afraid to use the tainted city water to wash their hands, even though hand-washing is a recommended method for limiting foodborne and other illnesses.

According to Jim Henry, environmental health supervisor for Genesee County, “People aren’t bathing because they’re scared. Some people have mentioned that they’re not going to expose their children to the water again.”

In an interview with CNN, Henry advised county residents not to rely on baby wipes, handed out for free at bottled water distribution centers, because they aren’t chlorinated, don’t kill the bacteria, and can’t replace thorough hand-washing.

However, others find no connection between the water problems and the uptick in shigellosis cases.

Marler Clark

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About this blog

The Shigella blog supplements Marler Clark’s Web site About Shigella, a site that provides information about Shigella, the symptoms and risks of infection, testing and detection of Shigellosis, and how to prevent the spread of the Shigella bacterium.